Mild Surgical Complications Increase When Residents Participate

A new study suggests that resident involvement in surgical cases is associated with a small increase in mild surgical complications, mostly caused by superficial wound infections.

Researchers at the Cleveland Clinic (OH, USA), the University of Limerick (Ireland), and other institutions studied data collected by the US National Surgical Quality Improvement Program between 2005 and 2007, and performed a matched comparative study comparing outcomes for 40,474 patients who underwent surgery with resident participation and 20,237 whose operations did not involve resident participation. The groups were matched based on age, sex, specialty, surgical procedure, morbidity probability, and important comorbidities and risk factors.

The results showed that resident involvement did not affect 30-day mortality, severe complications, or medical complications. But overall complications did increase from 6.7% to 7.5%, surgical complications rose from 6.2% to 7.0%, and mild complications went up from 3.5% to 4.4% when residents participated in an operative case. The increase stemmed from a spike in superficial surgical site infections (SSI), which rose from 2.2% to 3% when residents participated. The researchers also found that surgical trainees did prolong operative time, with the mean procedure time lasting 122 minutes compared with 97 for cases without residents. The study was published in the September 2012 issue of Annals of Surgery.

“Resident participation may by itself be a surrogate for complexity and disease severity, despite any attempts at controlling for all potential patient-, disease-, and operation-related factors,” said lead author and study presenter Ravi Kiran, MD, staff surgeon and head of the research section of colorectal surgery at the Cleveland Clinic. “There is a small overall increase in mild surgical complications but we are unsure if it is clinically relevant; the difference may be marginal.”

Related Links:
Cleveland Clinic
University of Limerick